Abstract
Research indicates that, despite physiotherapists’ comprehensive training in the basic sciences, manipulative (currently “musculoskeletal”) therapy is still dominated in the clinical setting by its original, now obsolete, structure-based “biomedical” model. This is further inexplicable in the light of evidence that not only the underlying “philosophy” but also several of the fundamental requirements of the clinical process itself which has the structural-mechanical model as its basis, have been shown to be flawed or at least irrelevant. The apparent inability of the profession to fully abandon outmoded “concepts” (and embrace the acknowledged science-based “best practice” biopsychosocial model) may have potentially undesirable consequences for both patients and therapists engaged in the management of (chronic) musculoskeletal pain and disability.
Highlights
Today in many parts of the world the standard of academic training in physiotherapy is high
Despite physiotherapists’ comprehensive training in the basic sciences, manipulative therapy is still dominated in the clinical setting by its original, obsolete, structure-based “biomedical” model
Though by no means the only example, this focus on pain at the molecular level is significant. It is certainly a far cry from the earlier world of manipulative physiotherapy where ritualised passive movement was king and pain was seen as essentially an “inconvenience” to its optimal delivery
Summary
Today in many parts of the world the standard of academic training in physiotherapy is high. Though by no means the only example, this focus on pain at the molecular level is significant It is certainly a far cry from the earlier world of manipulative physiotherapy where ritualised passive movement was king and pain was seen as essentially an “inconvenience” to its optimal delivery. It can only be assumed that persisting with strictly “how-to” manuals and excluding/limiting science-based mechanisms is deemed to have “survival value” [7-11]. This may be related to acute awareness of the relative simplicity of the modality (graduated stretch) and its threatened somewhat undesirable (“alternative”) associations [4,5]
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